Millions of Americans take prescription drugs every day. These prescriptions treat thousands of conditions. Some are even life-saving and can increase the person’s quality of life drastically. The downfall to prescription medications is that some can be quite costly, even with insurance coverage.
Furthermore, your insurance company may decide to deny certain, necessary prescriptions. However, paying out of pocket for some of these much-needed medications can be impossible. A Los Angeles prescription denial lawyer may be the key to getting your insurance company to approve a prescription drug your doctor has ordered. By fully examining the terms of your policy, an insurance denials lawyer can help make sure your insurance carrier is fully honoring their contract with you.
Reasons for Prescription Drug Denials
Health insurance companies are notorious for caring more about their financial health than the physical and mental health of the individuals and families they insure. One of the ways they accomplish this goal is by looking for different reasons to deny a claim. When a prescription drug is denied by a health insurance company, it may be for one of several reasons.
Not Enough Evidence to Support Need
An insurance company may deny payment for a prescription, even when it was ordered by a licensed physician. This may be because they believe they do not have enough evidence to support the need for the medication. Getting detailed information in writing explaining the medical need for a prescription drug, either from the physician directly or via the office manager may help.
Additionally, a Los Angeles prescription denial lawyer can help the insured write a letter to their insurance company explaining why this prescription is a medical necessity. It should include the experience of the insured with the medication and how alternative medications or treatment do not produce as positive a result as this particular prescription.
Lacks FDA Approval for Condition
Another defense health insurance companies may use to deny a prescription drug claim is purporting that the medication is not FDA approved for the condition that the doctor has prescribed it for. Providing the insurance company with facts about how the medication has been used to treat this specific condition, such as reliable studies or even letters from other patients who have successfully taken this particular drug for the same condition can also sometimes help. A prescription denial attorney in Los Angeles can help determine what evidence could help reverse the denial.
Prescription Drug Insurance Laws in Los Angeles
Patients have several rights under California laws regarding prescription drug coverage. One of these laws covers step therapy, or the practice of insurance companies to mandate that patients try other similar medications before prescribing the one specifically requested by their doctor.
As per California Health and Safety Code Section 1367.243, a prescription drug plan cannot require an insured individual to try and fail more than two prescription medications prior to allowing them access to the medication that was originally prescribed. The only exception to this law is if there is clinical evidence that supports the patient trying more than two prescriptions before trying a requested medication.
Let a Los Angeles Prescription Denial Attorney Help
Trying to get a prescription medication approved by your health insurance company can be frustrating. You may feel as if you are fighting an uphill battle and may even lose hope. However, a Los Angeles prescription denial lawyer can help.
An experienced attorney knows what it is like to have your insurance company deny a medication that you desperately need. They also know how California insurance laws apply in these circumstances.
Their passion for helping insured individuals combined with their knowledge of insurance law put them in a position to be able to effectively fight for you. Call today to learn more.
